This is Marthe and she had a Home Birth…
When Marthe was eighteen years old and newly married, she went into labour one Cape Town spring morning. She was living down the road from her Aunty Maggie and Aunty Martha’s house and the two busy body aunties came to see if the pains the expectant mother was complaining about were indeed the pains of labour, they were there to keep the nervous young husband at bay, and to send a young boy to summon the midwife. The local midwife soon arrived on her bicycle and stayed with young Marthe for three days before deciding to send the young woman off to Groote Schuur hospital. The labour was taking too long and the baby was not coming. The midwife was concerned. After three days of labour and after being transferred to the hospital, Marthe gave birth to a skinny little baby girl. The doctors were baffled as to why the tiny girl had taken so long to come. Eighteen months later, Marthe was in labour again. Again she was at home, and again the local midwife joined her. This time the labour seemed to be progressing smoothly and soon Marthe began bearing down. By some strange twist of fate, the house across the road caught alight. While Marthe easily heaved out a large ten-pound baby girl, a woman died as the house opposite burnt to the ground. (Birth and death walked side by side down that road that day…) Marthe was my grandmother and the large baby girl was my mother. Marthe was pregnant again three years later, and she gave birth easily, at home, attended by a midwife, to another girl. Smaller this time. Life went on and many things changed, especially my grandparents’ social status and when my grandmother fell pregnant in her thirties it was only natural, that this laatlammetjie(1) birth would take place in a hospital, under the care of the best doctors that money could buy. It was years later, when my grandmother was hard of hearing, and cataracts had begun to form in her eyes, that I took her along to a birth film festival I had organised in Cape Town at the Labia theatre. On the drive home, she divulged her birthing stories to me, and she admitted that giving birth at home, had been for her first prize and that paying all that money to have her baby “delivered” in a hospital had been a disappointment. After watching these beautiful birthing films that night, she had only one regret. She would have liked to have had a water birth! * (1) Afrikaans: a child born many years after his or her siblings * My grandmother died in France two years ago, whilst on holiday with my aunts. She had been quite ill and been a given a short time to live so she took herself and her daughters off on one last holiday and shopping spree before she passed away in Nice. She was cremated and has been at rest in a crematorium in Nice. This week my aunts bring her back to Cape Town where she will be buried, alongside my grandfather (who passed away over twenty years ago). Rest in Peace Jiajia, and welcome...
Read MoreI was a ‘Difficult Patient’
The women in labour must have NO STRESS placed upon her. She must be free to move about, walk, rock, go to the bathroom by herself, lie on her side or back, squat or kneel, or anything she finds comfortable, without fear of being scolded or embarrassed. Nor is there any need for her to be either ‘quiet’ or ‘good.’ What is a ‘good’ patient? One who does whatever she is told who masks all the stresses she is feeling? Why can she not cry, or laugh, or complain? – Grantly Dick-Read My mother, who was my midwife for my first birth said that it was a good thing I had not given birth in the hospital. She said that they would have knocked me over the head and ordered me to behave and shut up. I am not ‘a good patient’ in labour…no…I am what you would call ‘a difficult patient’. I moan. I complain. I shout. I scream. I sing. I stamp my feet. I demand. I swear. I growl. I froth at the mouth. I even throw things. Oh, I tried. I really did. I tried to be good. I promise. I tried those breathing techniques that are supposed to keep you calm and focused and good. And they would work for a little while. In early labour. But at some point I would have to admit defeat and throw the breathing techniques out the window. They did not help me. They hindered me and the process. I needed to let go, I needed to allow the waves of pain to drown me, I needed to howl and scream my way through labour, I needed to lose myself completely in the fire of pain. I whimpered and wailed my way through my first labour, my mother’s patient eyes and gentle touch carrying me. It was hard and the intensity of the pain was unexpected. I paced the room like a caged tiger and felt like I was a roast chicken being ripped apart by some glutton. It felt like the labour, the pains would never end. But I also felt exultant and strong, especially when I became a lion on the tip of a mountain, full of spears, bleeding, dying but still strong and powerful and roaring. I squatted and I shouted and I pushed out a 5kg baby when I knew I couldn’t. I was not a good labourer, although my midwife at my second birth whispered into my ear that I was as she rubbed soothing oils into my burning lower back. “Yeah right,” I thought, “I bet you say that to everyone…” but inside I loved those words, I needed them. I spat out the orange she had just offered me and with renewed energy, I roared as I arched my back in agonising pain. My second labour took me by surprise. They all did. All four of them. Something does make you forget the intensity and when the labour actually begins there is that moment where you go “oh shit!” and then the roller coaster ride begins and you have to hold on for the ride as you buck through the contractions. It was bloody sore but then again, it was also bloody amazing. I had not realised how strong I was and I did push ups and roared to ease the pains and was taken to a place, a white hot place on the other side of pain where pain did not exist. It was incredible. Shamanic almost. The third time I laboured my baby was ‘late’…he had spent a good...
Read MoreDo we Need More Midwives in South Africa?
Apparently, if you call up the South African Nursing Council (SANC) (under which all registered South African midwives must fall) then you will be told that there is a long list of registered midwives in South Africa – their database seems to reflect an adequate amount of trained and registered midwives. Midwives are known to improve the outcomes of births and yet here in South Africa, our maternal mortality rates do not reflect this. Since the Millenium Development Goals were set in 1990, with decreasing maternal mortality by 75% by 2015 being one of the goals, South Africa’s maternal mortality have risen. If you scratch below the surface, you will discover that South African midwifery training at present requires four years of nursing which includes only six months of midwifery. There is an option to study Advanced Midwifery at university level after qualifying as a midwife and some midwives may choose to go this route. What essentially happens, is that many nurses are trained who can call themselves midwives, are registered and listed as midwives, and can work as midwives but who may not choose to work as midwives, or who feel no particular compassion for the pregnant and labouring women they serve, or may not have a passion or drive for midwifery. And even if they do feel passionate about midwifery, they often feel inadequately equipped to work in the settings they are placed in after qualifying. Some Facebook support groups have sprung up for midwives in South Africa and they have grown as a place for midwives to voice their fears and concerns, as well as a place for them to share stories and information.When I see that midwives are too afraid to work in the labour ward – I feel that our midwifery education system has failed them. Jason Marcus and Jenna Morgan, both midwifery educators in South Africa, refer to the current South African midwifery training as ‘the fruit salad’ and both feel strongly that South Africa needs to look at the needs of our pregnant population and meet those needs through our midwifery training. At present, both feel that those needs are not being properly looked at and, therefore, are not being met. When I hear stories of abuse in South African maternity wards, from mothers, medical students, midwives, doulas and through the media (and I have witnessed it on numerous occasions), then I know that something vital is missing. That we are failing pregnant and labouring women. Last year, I sat with a support group of mothers from SWEAT (Sex Workers Education and Advocacy Taskforce) and discovered that out of about ten of the mothers present, four had chosen to give birth at home unassisted, some because of precipitous labour, but primarily because it felt easier and safer to give birth alone than to be mistreated and shunned. And when they called me a couple of weeks later to let me know that a first time single mother, who lived under a bridge and survived as a sex worker, had died whilst trying to birth on her own under that bridge, I knew our maternity system had failed her. When I drive past Red Hill informal settlement and I give lifts to the women who are hitch-hiking to have their antenatal check-ups, or to take their sick babies to the clinic and I hear the stories of how many women avoid those antenatal checks, or don’t even book at the hospital, and try to arrive at the hospital as late as possible, or not at all, because it is too far, or too tedious or because of how...
Read MoreHome birth as a trend?
All good things must come to a trend, so obviously, home birth in all its fabulousness is going to have to come to the forefront, especially with rumours flying around that the future queen of England, Kate Middleton, is possibly planning a home birth (which I believe to be untrue). But what is it about home birth that is attracting more and more South African women to this particular option? Lana Petersen and I have been running Home Birth South Africa for the last 5 years – something we started purely out of frustration because there was nowhere that a South African woman could go for information on this birthing option – i.e. there was a lot of information available online and in books on home birth but all in the UK, the USA and Australia and nothing which made it seems like a tangible and doable concept within the South African context. So, Home Birth South Africa has been going for the last five years, running quarterly gatherings and information sessions – a place where those interested in home birth, planning a home birth, have had a home birth, wanted one but didn’t get to have one, doulas, midwives, birth activists and those generally interested and who support it can gather to share, ask questions and discuss. The gatherings took place for a long time at Erin Hall in Rondebosch but these days take place at Norman and Jenny Skillen’s rock star mansion in Muizenberg. We usually gather in a circle and each person shares who they are and why they are there, they might share a story and ask some questions. Discussion inevitably ensues and we usually go over time. Over the years, the gatherings have grown in momentum and yesterday’s event attracted nearly forty people to it. Our website and data base grew out of the home birth gatherings when we realised that the need for information and stories needed to be available on a national level. The website gives information, answers questions, provides stories written and shared by South African mothers and families, and offers a directory of home birth friendly practitioners – we are always on the look out for more stories, contributions, information so please feel free to share by contacting us. Stories can be published anonymously. So what is it about home birth and why are we so passionate about it? In this article with photographer Leah Hawker we touch on what drives both Lana and me but I think to summarise, for both Lana and myself it is not home birth per se which is our agenda but being able to provide information and knowledge to women and their families that helps them tap into their own needs around birthing their babies. And both of us are in awe of women when that certain something is unlocked in labour and the new raging, power of that woman is opened as she finds a new part of herself. Innately women seem to want to give birth where they feel safest and most comfortable, and within the South African health care system, while medically very sound, that feeling of safety, of feeling cared for, of being nurtured, of being heard and valued, is so often not there. (And no, there are not really any midwife run birth centres for those women seeking the middle ground.) Not sure when it happened that healthy pregnant women were considered ‘sick’ and deemed only fit to birth in hospital and not sure how it happened that women accepted that this would be the norm. But what I do see are that...
Read MoreAre We Creating an Epidemic of High-Risk Women?
Two weeks ago I wrote about the first unnecessary caesar I attended. It was the first but it was also not the last. It did prompt me to do my homework and to really make sure that the women I was attending as a doula were well informed. One of the things I did was call up all the maternity wards of all the private hospitals here in Cape Town and ask them directly what their their caesarean section rates were. I knew from discussions with other doulas and midwives that many caesars were taking place but I did not have clear numbers. The conversations went something like this: “Hi…I am a doula supporting mothers wanting to birth vaginally in private hospitals here in Cape Town and I would just like to know what your caesarean rates are so that they can make an informed decision about where the best possible place to birth is.” Or something along those lines. Responses were everything from helpful and obliging to irritated, rude and irate: “Oh one doctor here has about a 60% caesar rate…he really tries, but the others are definitely around 80 – 90%” “About 65% but I think it is the private midwives that do deliveries here that bring the rates down…the doctors have much higher rates than that.” “Between 60 and 90%.” “I don’t see why we should divulge this sort of information, I don’t see how a high caesarean rate can make a difference to a woman’s chances to birth naturally!” “It is definitely upward of 80% but I am not telling you how much higher – I don’t think it is any of your business!” So in private hospitals in Cape Town, we are looking at a caesarean rate of 60 – 90%. And from my experience in two of the major government hospitals in Cape Town, it seems to be around 50% in the public sector. The World Health Organisation recommended a caesar rate of between 10 – 15% as being healthy, so WHY is our caesarean section rate so high? And why is it not my business to find out the caesarean rate of a hospital that is often promising to be supportive of women’s wishes to birth as they wished? And why is it suddenly okay to slice open perfectly healthy women and change their obstetric history forever? (I need to stress that I am not anti caesarean. I am eternally grateful for the operation that saves the lives of mothers and babies. I am not putting down this very necessary intervention and the skilled people who can perform it.) Since then I have worked within home birth midwifery practices and met midwives from all over the world who maintain a caesarean rate of between 2 and 20 %. Why do they get it right and the hospitals do not? I think the saddest and hardest thing for me is meeting the women who have undergone these unnecessary caesars. Who come with their stories. And who really want to give birth vaginally this time around, sometimes after one, sometimes after two, sometimes after more caesareans… I was induced at 38 weeks and didn’t progress so I had to have a caesar. The doctor said my baby was getting to big and I would never be able to birth her – but then she was an average size! I had a supportive doctor but she was on holiday when I went into labour and I got the doctor with the highest caesar rate in the hospital. The environment was too clinical for me, the beeping machines,...
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